Brain Pathology Case of the Month - September 2002

1Department of Neuropathology and 2Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Germany

Published on line in September 2002

CLINICAL HISTORY:

This 24 year old female presented with a history of three generalized seizures, the first of which had occurred 6 months before admission. Seizures usually occurred when she was trying to fall asleep and were characterized by contractions of both hands into fists, shaking, vomiting, cyanosis, non-responsiveness upon being addressed by her husband, and subsequent loss of consciousness. After the second seizure, which occurred 4 months after the first, she was treated with carbamazepin, however, suffered her third seizure only one month later. Ever since her last seizure she suffered from a persistent and increasing right-sided pressure headache. Neurological examination upon admission was normal.

RADIOLOGY:

The cranial MRI showed a small, well-circumscribed mostly cystic lesion, measuring approximately 1 x 1 cm in the left parieto-occipital region. The solid component consisted of only a thin margin involving the subcortical white matter and cortex. The lesion was hypo-intense in T1-weighted sequences (Fig. 1a) without contrast enhancement (Fig. 1b), and hyper-intense in T2-weighted sequences (Fig. 1c) without any perifocal edema. No calcification was observed. Based on the radiologic findings a low grade glioma, e.g. astrocytoma WHO grade II or ganglioglioma/gangliocytoma was suspected, and the patient was admitted for operation.

GROSS FINDINGS:

During the surgical exposure, the tumor was found not to reach the cortical surface and was localized using ultrasound. It was associated with a cyst that contained clear amber-coloured fluid. The tumor was excised completely. A tissue sample of firm, rubbery consistency and partly white, partly light brown colour was sent for histological evaluation.